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Background and objectives: In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The introduction of Manual Vacuum Aspiration (MVA) to treat incomplete abortion has improved the management of abortion complications. However, this technology comes with pain whose management has been a challenge. This paper explores the lived experiences of pain (management) during MVA to document the contributing factors. Methods: We used an ethnographic approach to explore girls and healthcare providers' experiences in offering and accessing post-abortion care in Kilifi County, Kenya. The data collection approach included participant observation and informal conversations in public health facilities and neighboring communities, as well as in-depth interviews with 21 girls and young women treated for abortion complication and 12 healthcare providers. Results: Our findings show that almost all patients described the MVA as the most painful procedure they have ever experienced. The unbearable pain was explained by various factors, including the lack of preparedness of health facilities to offer PAC services (i.e. lack of pain medicine, lack of training, inadequate knowledge and grasp of pain medication guidelines, and malfunctioning MVA kits). Moreover, the attitudes of healthcare providers and facilities management toward the MVA device limited the supply and replacement of MVA kits. Moreover, the scarcity of pain medicines also gave some providers the opportunity to abuse patients guided by their values, whereby they would deny patients pain medication as a form of "punishment" if they were suspected of inducing their abortion, especially adolescent girls. Conclusion: The study findings suggest the need for clearer guidelines on pain medication, value clarification and attitude transformation training for providers, systematizing the use of medical uterine evacuation using medical abortion drug and strengthening the supply chain of pain medication and MVA kits to reduce the pain and improve the quality of post-abortion care. [ABSTRACT FROM AUTHOR]

Th e enduring experience of hardship, in the form of layers of various crises, can become deeply ingrained in a society, and people can come to act and react under these conditions as if they lead a normal life. This process is explored through the analytical concept of duress, which contains three elements: enduring and accumulating layers of hardship over time, the normalization of this hardship, and a form of deeply constrained agency. We argue that decisions made in duress have a significant impact on the social and political structures of society. This concept of duress is used as a lens to understand the lives of individual people and societies in Central and West Africa that have a long history of ecological, political, and social conflicts and crises. [ABSTRACT FROM AUTHOR]

The Sahel has gained attention in international politics as one of the central theatres in the war on terrorism. International actors in this war seek alliances with states in the region, reinforcing the latter’s military strength and their legitimacy from outside. At the same time, increasingly-connected young populations question the legitimacy of their states, and contest that legitimacy from within and below. In the absence of states delivering any reasonable form of social contract, young people become torn between different governing orders and find themselves in a liminal space. In this article we present the cases of youth in Mali and Chad, who find themselves in a period of re-definition of their position in society and hence search for legitimate structures representation. In this search they may frame their belonging in terms of ethnicity, religion or political opposition – and increasingly also in adherence to global citizenship. New information flows and connectivity among young people in these regions, and between them and the diaspora, has given a new turn to their search for citizenship/belonging and rightful representation. However, whether their search will be successful in this geopolitical context is questionable. [ABSTRACT FROM PUBLISHER]

This article outlines the development of mobile telephony in the nascent Republic of South Sudan (ROSS). We focus specifically on Juba, during turbulent times from the end of the second Sudanese Civil War in 2005 to just after independence in 2011. We highlight the complicated political relations behind the establishment of mobile networks and the main functions and importance of the mobile phone throughout this period. Despite major technical obstacles, reconnecting with (war-) dispersed relatives, providing security in the post-CPA period marked by high insecurity and symbolizing hope and access to markets were important features of mobile phone use in Juba. Mobile phones were also essential to the rapid development of migrant dominated trade and business. Through this case-study we aim to shed light on the way in which (new) communication technologies become entangled with mobility, politics and entrepreneurship in a (post)war setting characterized by a displacement economy. [ABSTRACT FROM AUTHOR]

The article discusses the challenges faced by former child soldiers in Uganda after the conflict. Topics covered include the serious grievances of children as well as the resilience of children to violence. Also mentioned are the efforts of humanitarian agencies to address the mental health needs of the children.

Post-abortion care (PAC) counselling and the provision of contraceptive methods are core components of PAC services. Nevertheless, this service is not uniformly provided to PAC patients. This paper explores the factors contributing to young women leaving health facilities without counselling and contraceptive methods. The paper draws from an ethnographic study conducted in Kilifi County, Kenya, in 2021. We conducted participant observation in health facilities and neighbouring communities, and held in-depth interviews with 21 young women aged 15-24 who received PAC. In addition, we interviewed 11 healthcare providers recruited from the public and private health facilities observed. Findings revealed that post-abortion contraceptive counselling and methods were not always offered to patients as part of PAC as prescribed in the PAC guidelines. When PAC contraceptive counselling was offered, certain barriers affected uptake of the methods, including inadequate information, coercion by providers and partners, and fears of side effects. Together, these factors contributed to repeat unintended pregnancies and repeat abortions. The absence of quality contraceptive counselling therefore infringes on the right to health of girls and young women. Findings underscore the need to strengthen the capacities of health providers on PAC contraceptive counselling and address their attitudes towards young female PAC patients.